Provider Demographics
NPI:1104288406
Name:GALLEGO, JOSEPH DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:DAVID
Last Name:GALLEGO
Suffix:
Gender:
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:28 ATLANTIC AVE STE 226
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02110-3820
Mailing Address - Country:US
Mailing Address - Phone:507-215-4647
Mailing Address - Fax:769-206-4623
Practice Address - Street 1:28 ATLANTIC AVE STE 226
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-3820
Practice Address - Country:US
Practice Address - Phone:507-215-4647
Practice Address - Fax:769-206-4623
Is Sole Proprietor?:No
Enumeration Date:2016-03-25
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY560962084P0804X
NY2987432084P0804X
NJ25MA114181002084P0804X
CT615922084P0804X
MA2913282084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty